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Doxorubicin Congestive Heart Failure

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“A weekly dose schedule of doxorubicin was associated with a significantly lower incidence of congestive heart failure than was the usually employed every 3-week schedule.”

I understand that curing the cancer patient is oncology’s priority. In early 1994 I was diagnosed with a supposedly incurable blood cancer called multiple myeloma.  My oncologist prescribed my induction therapy to be a chemotherapy cocktail of three different chemos called VAD (vincristine, adriamycin and dexamethasone).

I developed a late stage side effect called chemotherapy-induced cardiomyopathy fully 15 years after the many cardiotoxic chemos that I underwent. 

When my oncologist prescribed VAD therapy in the spring of 1995 however, the success rate of this cardio-toxic chemo cocktail was 67% according to research.  My patient records show that my cancer did not respond to my first four courses of monthly VAD therapy. So my oncologist added a fifth monthly cycle of VAD, adding more cardio-toxic therapy to my ineffective regimen.

Adding to my increasing risk of chemotherapy-induced cardiomyopathy, my oncologist prescribed two rounds of high-dose cytoxan aka cyclophosphomide.

I don’t understand why I was prescribed VAD on a monthly schedule because the study linked and excerpted below citing “a weekly dose schedule of doxorubicin was associated with a significantly lower incidence of congestive heart failure than was the usually employed every 3-week schedule” was published in 1979. 

The issue, as I understand it, is the total cardiotoxic therapy that the cancer patients undergoes. For example, a myeloma specialist named Dr. James Berenson prescribed doxorubicin but at a tiny dose. The

  • Adriamycin
  • Busulphan
  • Cytoxan and 
  • Melphalan 

umulative dosages that I had were much, much higher. If you undergo a cardiotoxic chemotherapy regimen, get a baseline echocardiogram and consider evidence-based nutritional suppleementation that has been shown to protect the patient’s heart such as CoQ10, Curcumin, etc.

Have you or are you about to undergo a cardiotoxic chemo such as doxorubicin? If you’d like to learn more about chemotherapy-induced heart damage let me know-


Good luck,

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer 

Recommended Reading:

Doxorubicin Side Effects and Heart Problems

Factors That Affect Heart Damage:

  • A high dose of doxorubicin is more likely to produce heart damage. The total dose of doxorubicin received during a person’s life should be ideally less than 400mg per square meter (of the body surface). The risk of CHF with this dose is less than 1 percent. At higher doses, the chances of heart damage increase. Fortunately, most chemo schedules require lower doses.
  • The simultaneous use of other chemotherapy drugs that affect the heart e.g. high doses of cyclophosphamid

Risk factors for doxorubicin-induced congestive heart failure.

Potential risk factors responsible for development of doxorubicin-induced congestive heart failure were examined through retrospective analysis of 4018 patient records. The overall incidence of drug-induced congestive heart failure was 2.2% (88 cases).

The probability of incurring doxorubicin-induced congestive heart failure was related to the total dose of doxorubicin administered. There was a continuum of increasing risk as the cumulative amount of administered drug increased. A weekly dose schedule of doxorubicin was associated with a significantly lower incidence of congestive heart failure than was the usually employed every 3-week schedule.

An increase in drug-related congestive heart failure was also seen with advancing patient age. Performance status, sex, race, and tumor type were not risk factors. These data will enable clinicians to better estimate the risk/benefit ratio in individual patients receiving prolonged administration of doxorubicin. They also provide a basis for the investigation of less cardiotoxic anthracycline analogues or for designing measures to prevent doxorubicin-induced cardiomyopathy.”

Progressive Heart Damage Seen Two Decades After Adriamycin

“The cardiotoxicity of Adriamycin (doxorubicin) does not fade away, even after two decades or more.

A median 22 years (range 15-27.5) after they were treated with Adriamycin for osteogenic sarcoma or malignant fibrous histiocytoma, the cardiac status of 22 long-term survivors continues to worsen, according to Dutch researchers.

The longitudinal assessment of cardiac function in the 22 anthracycline-treated survivors found systolic dysfunction in more than a quarter of the patients and diastolic dysfunction in nearly half

Longitudinal studies of cardiac function in long-term childhood-cancer survivors are scarce and frequently are limited to a median follow-up shorter than 13 years, they said.

In the current 2004 study, patients (median age 39) originally treated between 1977 and 1990 were followed for 15 to 27.5 years. Combination chemotherapy included moderate-to-high doses of Adriamycin (225-550 mg/m2; cumulative dose 360 mg/m 2)

Twenty-seven percent of the patients had systolic dysfunction and 45% had diastolic dysfunction. This compared with the 1997 follow-up when 9% had systolic dysfunction and 18% had diastolic dysfunction. Heart-rate variability in 19 available patients showed further deterioration compared with earlier results, the researchers reported.

Although in the earlier analyses of these patients, systolic dysfunction had not progressively decreased in the nine-year and 14-year follow-ups, the number of patients with abnormal systolic function increased significantly in the extended follow-up.

In addition, all six of the patients with decreased systolic function at the current assessment had an elevated wall motion score index. Four had diffuse wall motion abnormalities, and two had regional abnormalities, suggesting ischemic heart disease (confirmed in one by PET scan), the investigators said.

Measurement of blood pressure, although elevated in eight patients, did not differ significantly from sex- and age-matched controls recruited from a group of 419 healthy controls, according to the investigators.

All had cardiac assessments at nine years (1992), 14 years (1997), and at 22 years in the current assessment. Patients were assessed by blood tests, blood pressure measurement, Doppler echocardiography, ECG, and 24-hour Holter monitoring, among other studies…”



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